BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1570| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1570 Author: Chesbro (D) Amended: 8/18/14 in Senate Vote: 21 SENATE HUMAN SERVICES COMMITTEE : 4-0, 6/24/14 AYES: Beall, DeSaulnier, Liu, Wyland NO VOTE RECORDED: Berryhill SENATE APPROPRIATIONS COMMITTEE : 5-0, 8/14/14 AYES: De León, Hill, Lara, Padilla, Steinberg NO VOTE RECORDED: Walters, Gaines ASSEMBLY FLOOR : 79-0, 5/28/14 - See last page for vote SUBJECT : Residential care facilities for the elderly SOURCE : California Assisted Living Association California Council for the Alzheimers Association LeadingAge California DIGEST : This bill, effective January 1, 2016, requires the certification program for an applicant for licensure of a Residential Care Facility for the Elderly (RCFE) to consist of 100 hours of course work and a state-administered examination of no less than 100 questions; requires the examination to reflect the uniform core of knowledge required and requires the Department of Social Services (DSS) to, every other year, review and revise the examination to reflect changes in law and regulations; changes the certification fee to an amount not to CONTINUED AB 1570 Page 2 exceed $150 and requires staff members of RCFEs who assist residents with personal activities of daily living to receive 20 hours of training before working independently with residents, an additional 20 hours within the first four weeks of employment, and an additional 20 hours annually, as prescribed; and applies the training requirements specific to dementia care to all RCFEs. ANALYSIS : Existing law: 1.Establishes the Residential Care Facilities for the Elderly Act (Act), which provides for DSS to license and regulate RCFEs as a separate category within the existing residential care licensing structure of DSS. 2.Requires a license applicant and an RCFE administrator to successfully complete a certification program approved by DSS, which includes a minimum of 40 hours of classroom instruction including a uniform core of knowledge, as specified. 3.Specifies that an RCFE administrator certification is valid for two years and that recertification requires 40 hours of continuing education. Provides through regulation that an applicant for licensure is required to meet the requirements for initial certification of administrators. 4.Provides that the initial certification of administrators shall include successful completion of a department-approved program, passage of a written test administered by DSS within 60 days, and a criminal records clearance. 5.Requires DSS to develop requirements for a uniform core of knowledge for the initial certification and continuing education requirements for licensees, administrators and staff of RCFEs. Provides that this knowledge base shall include basic understanding of the psychosocial and physical care needs of elderly persons. 6.Provides that RCFE staff members who assist residents with activities of daily living shall receive at least 10 hours of initial training within the first four weeks of employment and at least four hours annually thereafter. 7.Requires DSS to develop a uniform assessment tool to be used CONTINUED AB 1570 Page 3 by all RCFEs in identifying resident needs for service and assistance with daily living. 8.Requires facility personnel to be sufficient in numbers and competent to provide the services necessary to meet resident needs. Provides that DSS may require any facility to provide additional staff whenever if determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require additional staff. This bill: 1.Increases the required licensee certification training to 100 hours of coursework, at least 60 hours of which is required to be attended in person. 2.Expands the required state-administered examination to no less than 100 questions, increases the fee submission to no less than $150, and allows an applicant to have access to the RCFE Act and related regulations, during the examination. 3.Expands the required uniform core of knowledge to additionally include: A. Medication management, including use, misuse, and interaction of drugs commonly used by the elderly, including antipsychotics, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. B. Managing Alzheimer's disease and related dementias, including nonpharmacologic, person-centered approaches to dementia care. C. Managing the physical environment, including maintenance and housekeeping. D. Residents' rights, and the importance of initial and ongoing training for all staff to ensure residents' rights are fully respected and implemented. E. Cultural competency and sensitivity in issues relating to the underserved, aging, lesbian, gay, bisexual, and CONTINUED AB 1570 Page 4 transgender community. F. Postural supports, restricted health conditions, and hospice care. 1.Requires DSS, no later than July 1 of every other year, to review and revise the examination in order to ensure the rigor and quality of the examination, and to ensure, on an annual basis, that the exam is not in conflict with existing law. Permits DSS to convene a stakeholder group to assist in developing and reviewing test questions. 2.Requires DSS to adopt regulations to require staff members of RCFEs who assist residents with personal activities of daily living to receive appropriate training consisting of 40 hours training. Specifies that a staff member shall complete 20 hours, including six hours specific to dementia care and four hours specific to postural supports, restricted health conditions, and hospice care, before working independently with residents. Specifies the remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. Permits the training coursework to utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. Requires the additional 16 hours to be hands-on training. 3.Requires, in addition to the above, training requirements to also include an additional 20 hours annually, eight hours of which are required to be dementia care training, four hours of which are required to be specific to postural supports, restricted health conditions, and hospice care. Requires this training to be administered on the job, or in a classroom setting, or both, and may include online training. 4.Clarifies that all RCFE direct staff are required to meet the following training requirements: twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which are required be completed within the first four weeks of employment. 5.Permits DSS to establish the subject matter required for the training in consultation with provider organizations and adds CONTINUED AB 1570 Page 5 the following to the currently required topics: A. Dementia care, including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. B. The special needs of persons with Alzheimer's disease and dementia, including nonpharmacologic, person-centered approaches to dementia care. C. Cultural competency and sensitivity in issues relating to the underserved, aging, lesbian, gay, bisexual, and transgender community. 1.Specifies the above provisions do not apply to certified nurse assistants, licensed vocational nurses, and registered nurses, with specified exceptions. 2. Makes the above provisions operative on January 1, 2016. Background Residential Care Facilities for the Elderly. Within California's continuum of long term care, situated between in-home care and skilled nursing facilities, is the RCFE, also commonly called Assisted Living, Board and Care, or Residential Care. There are approximately 8,000 Assisted Living, Board and Care, and Continuing Care Retirement homes that are licensed as RCFEs in California. These residences are designed to provide homelike housing options to seniors and other adults who need some help with activities of daily living, such as cooking, bathing, or getting dressed, but otherwise do not need continuous, 24-hour assistance or nursing care. Increasingly residents are entering RCFEs with significant health needs including diabetes, bedsores, or require the use of oxygen tanks, catheters or colostomies. Licensee and Administrator training requirements. Existing law requires prospective licensees and facility administrators to complete a certification program approved by DSS consisting of 40 hours of classroom instruction. CONTINUED AB 1570 Page 6 Typically, the 40-hour training requirements are met through private vendors who have been approved by DSS to conduct these trainings. The courses are generally scheduled as four, consecutive, 10-hour-day trainings, costing approximately $200 to $300. Following the training, prospective administrators are required to pass a 40-question test administered by DSS that has not been changed since its initial release. Approximately 500 individuals take the exam every month. Reportedly, the several versions of the test are available online to be studied in advance and few individuals fail the exam. Licensees must only pass their initial certification and are not required to maintain a current certification, which expires after two years. Additionally, corporate owners of a facility, who are not the official licensee, are not themselves required to be licensed or have any training despite having financial and managerial control over the facilities they manage. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes According to the Senate Appropriations Committee: Significant one-time and ongoing costs potentially in excess of $350,000 (General Fund) for DSS to develop and revise regulations, review and approve certification programs, administer and periodically revise the examination for RCFE licensees, and establish the subject matter required for training for direct care staff. These costs would be offset by the increase in fee authority. Significant increase in training costs to employees and/or facilities to meet the enhanced initial and continuing education training requirements imposed. Potential minor non-reimbursable local enforcement costs for misdemeanor violations of the provisions of the Act pursuant to this measure. SUPPORT : (Verified 8/18/14) California Assisted Living Association (co-source) California Council for the Alzheimer's Association (co-source) CONTINUED AB 1570 Page 7 LeadingAge California (co-source) ActivCare Living Belmont Village Senior Living Brookdale Senior Living Byron Park Senior Living California Commission on Aging Cal PACE Capriana Senior Living The Carlisle Chancellor Place of Murrieta Chancellor Health Care, Inc. Congress of California Seniors Cypress Place Senior Living Emeritus at Alhambra Emeritus at San Juan Capistrano Huntington Terrace Senior Living Inn at the Park Senior Living MBK Senior Living Mirage Inn Senior Living Sandi Flores, RN The Stratford Sierra Pointe Vintage Senior Living Sunrise Senior Living of Beverly Hills, La Jolla, Mission Viejo, Oakland Hills, Studio City, Westlake Village, and Yorba Linda Vintage Golden Gate OPPOSITION : (Verified 8/18/14) Community Residential Care Association of CA Consumer Advocates for RCFE Reform ASSEMBLY FLOOR : 79-0, 05/28/14 AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom, Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley, Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A. Pérez, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner, CONTINUED AB 1570 Page 8 Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins NO VOTE RECORDED: Vacancy JL:nl 8/18/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED